TDI Treatment Prevalence:- Draft Guidelines
TDI treatment prevalence
FINAl guidelines
November 2014
Aknowledgments
Authors:Linda Montanari, Luis Royuela, Bruno Guarita, Marica Ferri, Sandrine Sleiman, Dagmar Hedrich, André Noor, Alessandro Pirona, Julian Vicente
Contributors:
TDI experts who contributed to the development of this project and participated with the participation in the working groups in 2006 and 2013 on drug treatment prevalence
Momtchil Vassilev, Bulgaria
Jerome Antoine, Belgium
Vlastimil Necas, Czech Republic
Bela Studnickova, Czech Republic
Tim Pfeiffer, Germany
Martin Steppan, Germany
Suzi Lyons, Ireland
Ioulia Bafi, Greece
Laure Vaissade, France,
Anna Peterfi, Hungary
Tamás Koós, Hungary
Bruno Genetti, Italy
Marcis Trapnecieris, Latvia
Martin Busch, Austria
Alexander Eggerth, Austria
Janusz Sieroslawski, Poland
Domingo Duran, Portugal
Graça Villar, Portugal
Wil Kuijpers, The Netherlands
Anton W. Ouwehand, The Netherlands
Martta Forsell, Finland
Bert Gren, Sweden
Charlotte Davis, United Kingdom
Michael Donmall, United Kingdom
Jonathan Knight, United Kingdom
Collaborating partners: TDI countries’ experts (from the 2013 TDI expert meeting)
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TDI Treatment Prevalence:- Draft Guidelines
Jerome Antoine, Belgium
Momtchil Vassilev, Bulgaria
Vlastimil Necas, Czech Republic
Bela Studnickova, Czech Republic
Claudia Ranneries, Denmark
Tim Pfeiffer, Germany
Elena Alvarez, Spain
Kaire Vals, Estonia
Suzi Lyons, Ireland
Anastasios Fotiou, Greece
Christophe Palle, France
Tanja Bastianic, France
Bruno Genetti, Italy
Ioanna Yasemi, Cyprus
Marcis Trapnecieris, Latvia
Ernestas Jasaitis, Lithuania
Sofia Lopes Costa, Luxembourg
Anna Peterfi, Hungary
Tamás Koós, Hungary
Roberta Gellel, Malta
Chirstine Marchand-Agius, Malta
Alexander Eggerth, Austria
Wil Kuijpers, The Netherlands
Janusz Sieroslawski, Poland
Marta Struzik, Poland
José Padua, Portugal
Aurora Lefter, Romania
Ana Maria Teodorescu, Romania
Lubomir Okrulica, Slovakia
Romana Stokelj, Slovenia
Tuulma Väänänen, Finland
Roger Holmberg, Sweden
Bert Green, Sweden
Charlotte Davis, United Kingdom
Joanhatan Knight, United Kingdom
Grethe Lauritzen, Norway
Dragica Katalinic, Croatia
Mehmet Akgun, Turkey
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TDI Treatment Prevalence:- Draft Guidelines
Table of Contents
Introduction......
History of the TDI Treatment prevalence Project
Purpose and rationale of the TDI Treatment Prevalence
Guidelines for data collection on TDI Treatment Prevalence
1) Definitions
1.1) Drug Treatment Prevalence
1.2) Case definition
1.3) Drug Treatment
1.4) Start of treatment
1.5) End of treatment
1.6) Treatment episode
1.7) Treatment status
1.8) Treatment centre type
2) Item list
2.1) Mandatory items
2.2) Voluntary items
4) Graphic on case definition: inclusion and exclusion criteria
References
Introduction
The objective of the Treatment demand indicator is to collect information in a harmonised and comparable way across all Member States on the number and profile of people entering drug treatment (clients) during each calendar year. Although the name of the Indicator is the ‘Treatment demand indicator’, the indicator collects information on people entering treatment. The TDI is widely recognised as the instrument for collecting and reporting data on people entering treatment for their drug use in and outside Europe, as an indirect indicator of the unobserved level and characteristics of people that are potentially in need to demand drug treatment (EMCDDA, 2012). In this sense the TDI indicator complement the problem Drug Use Indicator (PDU) in monitoring extent and, in particular, patterns of problem drug use in Europe.
Beside the users who start a drug treatment for their drug use, there is a large group of people who stay in treatment for a long period due to the chronic or long term nature of their addiction.
In the last 10-15 years, opioid substitution treatment has expanded in most EU countries and the treatment population in these countries includes a growing proportion of clients who entered treatment for heroin problems and have remained in opioid substitution treatment (OST) for a long period of time. Therefore, in many countries, there is a considerable number of clients in continuous, long-term substitution treatment, who do not re-enter treatment again. Cocaine, amphetamine or cannabis clients are less affected by this situation, but some of them can also be in other forms of long-term treatment. For that reason, it has become necessary to estimate the number of those people in continuous or long term treatment to assess the number and basic characteristics of this group of clients.
Long term treatment clients, as well as clients in treatment at the start of the year (who have started earlier), are not captured by the Treatment Demand Indicator, as this tool only collects data on people entering drug treatment, excluding those who remainin treatment from one year to the next.
In order to provide a better picture of the total treated population in centres reporting to the TDI system, including the people who are in treatment (not entering), it is necessary to implement a project which complements the TDI by collecting information on those in treatment at the start of the year.
A project called “TDI Treatment Prevalence” was initiated in 2006 and is now completed with the publication of the current guidelines.
History of the TDI Treatment prevalence Project
In the 2004 Treatment Demand Indicator expert meeting, a discussion on the need to collect data on the total treated population in centres reporting to the TDI system took place and some TDI expertsexpressed the need to report data not only on clients entering treatment (incident cases), but also on clients in treatment at the start of the year. Those data would provide information on the total treated population and on the general impact of drug treatment on the drug problem. This would also allow having an overview on the size and characteristics of the total treated population and on the treatment capacityof drug specialised treatment centres in the European countries (see Meeting minutes:
The discussion continued in the meeting of the EMCDDA Scientific Committee in 2005, where it was suggested to extend the EMCDDA TDI data collection to the prevalent cases. In the same year a working group of TDI experts with nine volunteer countries met to discuss the feasibility of data collection on TDI treatment prevalence. The outcomes of the working group were presented during the 2005 TDI expert meeting(
A pilot data collection was carried out in the 9 volunteer countries in 2006. The first results of the pilot data collection,presented during the TDI expert meeting in September 2006,clearly showed that a large part of the treated clients was not included in the TDI data collection. In 2007a feasibility assessment was conducted with all the National Focal Points to verify the possibility of collecting data on the total treated population ([1]).According to the answers to the survey, most countries (23) declared that they were able to provide data on TDI drug treatment prevalence, as it was considereda relevant issue in the area of drug monitoring and drug treatment planning.Of the 23 countries who agreed to introduce the data collection on treatment prevalence as part of the EMCDDA data collection tasks, 15 were already collecting TDI treatment prevalence data and 8 were in the position to introduce it in the near future. Only 5 countriesstated that they would have not been able to introduce a data collection on TDI treatment prevalence. For 3 of them the reasons were related to difficulties in implementing the data collection in their monitoring system and for 2 countries the main reason was the scarce relevance attributed to the TDI treatment prevalence projectin their national programmes.
A second pilot data collection was carried out in 2008 with 14 volunteer countries ([2]). The results confirmed the picture described in 2006: a large number of clientsare continuing treatment from one year to the next; those clients have a social and drug use patterns profile substantially different from that of the clients entering drug treatment, particularly concerning age, substance of use and social conditions. Among those who are continuing in treatment from one year to the next there were more clients reported as older opioids users, unemployed and with marginal social conditions.
After the 2008 data collection, the project slowed down because of the launch of the TDI revision process and the implementation of a complementary project aiming to estimate the number of the total treated population, particularly those in opioid substitution treatment.
With the last developments in the area of treatment monitoring and, especially, the adoption of the EMCDDA treatment monitoring strategy, the project was re-launched and prepared for the implementation. The Treatment Monitoring Strategy foresees a framework for monitoring drug treatment in Europe which includes several components, including the TDI, the Treatment system ‘maps’, providing an overview of the treatment system, a methodological toolkit for estimating the number of people in drug treatment and a facility survey to determine characteristics of facilities but also to complement and cross-validate information on clients collected through other sources. At European level, the proposal aims to make offer and utilisation of drug treatment more transparent and to enhance more recent EMCDDA work areas, especially the estimation of overall treatment coverage and treatment quality and best practice information (EMCDDA, 2012).
The current guidelines aim to harmonise the data collection on TDI Treatment Prevalence in the centres reporting to the TDI system and to define a minimum data set common to all European countriesconcerning the data collection on the total treated population.
Purpose and rationale of the TDI Treatment Prevalence
The project of TDI Prevalence is conceived as a data collection supplementary to the TDI data collection, as it also includes data on people in treatment at the start of the year. In addition to the data on people entering (or re-entering) drug treatment, which are included in the Treatment Demand Indicator, the data on TDI Treatment Prevalence will also include the clients that have been in treatment during the year, but that have not generated a TDI treatment entry, because they are in “continuous” treatment since previous year(s). For that reason the project is called: TDI Treatment Prevalence.
The information on TDI Treatment Prevalence has three purposes:
1) to help improving the picture of the population with drug problems, even when they are considered as stabilised in treatment. These clients may not be considered as problem drug users, as they are stabilised in treatment; data on those clients However it is still important to estimate the number, the current situation and basic characteristics of those drug users stabilised in drug treatment;
2) to help estimating the “total number of people in contact with treatment services”. In some countries data on TDI Treatment Prevalence can be a good approximation of the total number of treated clients, whereas in other countries it will be a relevant component to be complemented by other methods. The estimate of the total number of people in contact with treatment services will be used to estimate the “treatment coverage”, as extent of people in need for treatment who are reached by the treatment services
3) to have information on treatment capacity and activity, which can be complemented by other tools and indicators. The information on the total number of people in treatment, even if only covering some part of the treatment system, will provide better information on the size of specialised drug treatment and the activity carried out and not related to treatment entries.
In some countries, it will be possible to obtain the information on TDI Treatment Prevalence without additional data collection. This is the case of countries where an electronic system with a central database is in place,allowing to determine the situation of all clients as being “in treatment/not in treatment” at each moment. In other countries it can be feasible to conduct a periodical data collection on all clients in treatment at a given moment of the year.
Data collection on TDI Treatment Prevalence will be built on the existing TDI data reporting. This methodological approachis only motivated by practical reasons: the TDI monitoring system is well developed and implemented in most countries and it is harmonised at European level; therefore the data collection and reporting should be based on the TDI system. This implies that the TDI Treatment Prevalence should report data on the same treatment units covered in the TDI data collection and it is the priority criterion when a choice has to be made in the definition of the case (client) to be reported.
The TDI Treatment Prevalence should therefore report data on clients entering treatment and on clients in treatment at the start of the year: the total number of cases reported in the TDI Treatment Prevalence should be the sum of those two groups – those reported in the TDI + clients who are in treatment at the start of the year; no clients should be reported twice. The priority should be given to the TDI case definition for case reporting: i.e. a case who is in treatment at the start of the year and re-enter treatment after a treatment’s end or after six months of treatment interruption should be recorded as client entering treatment (TDI case) and not as client in continuous treatment (see more details in the case definition, treatment status and graphic).
It is finally important to consider that the clients who are still in treatment at the start of the year can be in treatment since a short time or long time and in data analysis it would be important to distinguish between the two groups, as often they present different profiles both in terms of patterns of drug use (e.g. cannabis clients VS heroin clients) and social characteristics (e.g. younger and older clients).
Guidelines for data collection on TDI Treatment Prevalence
1) Definitions
1.1) Drug Treatment Prevalence
Drug Treatment Prevalence indicatesthe prevalence of all clients who are in drug treatment during a reporting year (1 January to 31 December) in a country.
Purpose
The TDI Treatment Prevalence project aims to provide the number of the treated population, who is reported within the TDI system, their basic characteristics and patterns of drug use. The clients are drug users treated in specialised drug treatment centres in a country during the entire year. Beside the clients who enter drug treatment during a year, a large part of the treated population remains in treatment from one year to the next.
Inclusion criteria
The TDI Treatment Prevalence project includes all clients who enter and stay in drug treatment during a year.
Exclusion criteria
Drug clients who have undergone drug treatment during the year, prior the reporting year (until the 31st of December of the preceding year) and do not re-enter treatment during the reporting year.
Methodological considerations
The methods for collecting TDI Treatment Prevalence data may differ according to the organisation of the country. Possible methods to be used are:routine data collection based on a register of clients recorded in a database during the reporting year or census capturing the situation of the clients (or a sample of clients) in one given day/week, which is then extrapolated on the basis of flow information to a year, estimates based on a sample of treatment providers.
The countries may opt for one of the two methods, according to their organisation and resources. It is important to indicate the chosen method and describe it in detail the methodological section for data collection and reporting. In order to select the client to be included see the graphic in section 4.
1.2) Case definition
A case is a client who is in treatment at a treatment centre during the calendar year: 1 January to 31 Decemberfor problems created by his/her drug use. He can start a drug treatment episode or continues a treatment episode from previous year(s) ([3]).
Clients should be counted just once and rules for control of double counting applied according to explanations presented in the TDI Protocol ver. 3.0 (EMCDDA, 2012).
Purpose
To identify in a reliable way people with drug problems who are in treatmentand describe their general profile and drug use patterns, with the purpose to use the information for assessing the size of the total population in drug treatment, the profile of those who are in long time treatment and have some indication on treatment capacity in Europe.
Inclusion criteria
1. Clients who enter treatment during the reporting year, as defined by the TDI Protocol ver. 3.0.
2. Clients in treatment on the 1st of January of the reporting year who started their treatment in the previous year or earlier, and do not have an end of treatment as defined in section 1.5 followed by a new treatment episode within the reporting year, i.e. they do not qualify as a treatment entrant as defined by the TDI Protocol ver. 3.0.
Exclusion criteria
1. Drug clients who are not in treatment during a year; or clients who have concluded a drug treatment during the year prior the reporting year (until the 31st of December of the preceding year) and do not re-enter treatment during the reporting year..
Methodological considerations
See 1.1 – Drug Treatment prevalence
The TDI Treatment Prevalence project is a supplement of the TDI data collection.
A graphical presentation is provided in Section 4 — Case definition — Graphical description
1.3) Drug Treatment
Drug treatment is defined as an activity (activities) that directly targets people who have problems with their drug use and aims at achieving defined aims with regard to the alleviation and/or elimination of these problems, provided by experienced or accredited professionals, in the framework of recognised medical, psychological or social assistance practice.This activity often takes place at specialised facilities for drug users, but may also take place in general services offering medical/psychological help to people with drug problems (see also ‘Treatment Centre’).
Purpose